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As hospitals deal with growing numbers of obese mothers-to-be, Canada’s fertility specialists are considering guidelines over whether they should be helping severely obese women get pregnant.

Doctors opposed to a weight cutoff for in vitro fertilization say denying obese women access to IVF would smack of discrimination, while those in favour of restricting access based on weight say it’s purely a medical issue, and not a social one.

Recently published research involving nearly 7,000 women who gave birth at The Ottawa Hospital found the heavier the woman, the greater her risk of pregnancy-repeated complications, including preeclampsia — a potentially life-threatening rise in blood pressure — gestational diabetes and emergency caesarean sections.

Risks to babies include premature birth and stillbirths, as well as a higher risk of spinal abnormalities and other birth defects.

“Right now, many of us are confused as to whether or not we should restrict treatment by weight,” said Dr. Jason Min, chair of the clinical practice guidelines committee of the Canadian Fertility and Andrology Society.

“We think there are more adverse outcomes if you do have a higher BMI. But whether or not that actually says you shouldn’t treat somebody who is heavy, I think that’s a very complicated issue and will ultimately require a lot of input from the stakeholders before we formalize that kind of guideline.”

The issue sparked a firestorm of debate at the group’s annual general meeting three years ago.

“There is no doubt — there is going to be bun fights over this one. The guidelines are not going to be easy,” said Toronto fertility specialist Dr. Carl Laskin.

“Those that feel that there’s no reason for a cutoff think that, if you can manage to do the procedures safely, then why should there be a cutoff?” said Laskin, a past president of the CFAS.

“To me, it’s a medical issue. It is not a discrimination issue. (Obese) women are running risks in pregnancy, and if they’re running risks in pregnancy, why should you be helping them get pregnant?”

Laskin has a BMI cut off of 35. “Mine is a brick wall,” he said. Other clinics will go as high as 40. Some have no cut off.

Laskin said obesity makes IVF technically more difficult. With IVF, eggs are retrieved from the woman’s ovaries via an ultrasound-guided needle. “But you may have difficulty getting to the ovary,” Laskin said. The ovary tends to be pushed up higher in the woman’s anatomy and excess fat can make it harder to visualize the ovaries on ultrasound.

Obese women also tend to respond more poorly to fertility drugs. “You have to use a lot more drug to get a reasonable response,” Laskin said.

“When I do see women with BMIs that are high, I work with them,” he said. “I don’t think it’s right to say, ‘you’re too heavy, go away and lose X amount of pounds and then call me.’

“I work out a plan for them. I say, ‘this is who you want to see, these are the options you can look at to lose weight, yes, you may have been there before but now you have a bigger reason for it.

“I give them all the risk factors and then I bring them back every three months until they are in a range that I believe is safe.”

In B.C., private IVF clinics outside hospitals are not permitted to perform egg retrievals in women with a BMI over 38.

Alberta has no restrictions, said Min, of Calgary’s Regional Fertility Program.

“In Calgary, at our clinic, we don’t have a BMI cutoff above which we won’t treat a patient with IVF,” said Min. “We’re not at a point where we think it’s fair or ethical to limit access to treatment based on a person’s weight.”

According to Statistics Canada, 23 per cent of Canadian women are obese. A woman with a body mass index of 30 or more is considered obese.

Obese women not only have more difficulty getting pregnant with IVF, they are also at higher risk of complications during delivery.

“Surgically, when you have to do a caesarean section, it’s very difficult and very dangerous because the blood loss, infections — all your complications are more common,” said Dr. Mark Walker, a high-risk obstetrician at The Ottawa Hospital

“You’re operating through a much more challenging operating field.”

Some pregnant women now have BMIs into the 60s, 70s and 80s, he said. The phenomenon is forcing obstetricians to re-fit their weigh-in rooms with scales that can accommodate women weighing more than 350 pounds while maternity wards are buying extra-wide chairs and beds and stronger operating tables.

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